Factors Associated with Length of Inpatient Stay Among Korean Middle-Aged and Older Adults

Background and Purpose:The average length of inpatient stay (LOS) has significantly declined over the past two decades. Given that hospitalization is the most expensive form of healthcare, shortening LOS is considered an economic strategy to reduce healthcare costs. Although previous studies have well documented that patient, hospital, regional characteristics are associated with LOS, little is known about the pattern of LOS over time and the factors associated with LOS among Korean middle-aged and older adults who are vulnerable in accessing appropriate and adequate healthcare due to their unique cultural characteristics. Thus, the purpose of the study was to examine the trajectory of LOS among Korean adults and its associated factors by using nationally representative community residents in Korea.

Methods:Data were obtained from the Korean Longitudinal Study of Ageing (KLSA). The KLSA is a nationally representative survey with community residents who are 45 years and older in Korea. Since 2006, the KLSA has been conducted in every other year. The sample of the present study consisted of 8668 individuals. As the outcome variable, the length of inpatient stay was measured by asking how many days they spent at the hospital in a given year. Guided by Andersen behavioral model of healthcare utilization, predisposing, enabling, and need factors were controlled in the models. To examine the trajectory of LOS and its associated factors among Korean middle-aged and older adults, latent growth modeling was employed.

Results:The average LOS was 3.8 days, and increased by 0.65 days per year. Although income level was not directly associated with LOS, the poor were more likely to have longer LOS than their non-poor counterparts and its pattern remained over time. The number of comorbid health conditions, the Instrumental Activities of Daily Living (IADL) score, and perceived health status were found to be associated with LOS. Furthermore, the higher level of depressed symptoms tended to increase LOS, and this pattern also continued over time. Employment status was also found to be positively associated with LOS and remained over time. However, both marital status and education were found not to be related to LOS among Korean middle-aged and older adults.   

Conclusions and Implications: Findings of the study suggest that the average LOS has slightly increased over time among Korean middle-aged and older adults. Consistent with the findings of previous studies, we also confirmed that the complexity of health conditions (e.g., the number of comorbid conditions and depression) increased LOS. To provide cost-effective treatments for people with comorbid health conditions, healthcare providers should establish collaborative approach with various helping professionals. Furthermore, by developing healthcare resources in the community (e.g., affordable residential facilities), policymakers should make an effort to shortened LOS, which, in turn, reduce healthcare costs while providing quality of care.